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Need for specialized neuro-oncology units in low- and middle-income countries: Lessons learned from the COVID-19 pandemic 低收入和中等收入国家需要专门的神经科:从新冠肺炎大流行中吸取的教训
Pub Date : 2021-07-01 DOI: 10.4103/glioma.glioma_11_21
J. Robledo-Arias, Veronica Arango-Machado, Michael Ortega-Sierra, Ivan Lozada-Martinez
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引用次数: 0
Application and prospect of radiomics in spinal cord and spine system diseases: A narrative review 放射组学在脊髓和脊柱系统疾病中的应用与展望
Pub Date : 2021-07-01 DOI: 10.4103/glioma.glioma_14_21
Chao Ma, Guihuai Wang
Spinal cord and spine system diseases are complex and diverse, and prognosis is often poor. Therefore, early diagnosis is essential, especially for spinal system tumors, which are malignant nervous system tumors that have the highest mortality and disability rates. Accurate diagnosis avoids unnecessary operations. Traditional medical imaging diagnosis remains at the level of anatomical morphology, and there is a considerable amount of useful information that can be extracted and utilized. Radiomics is a new method of medical imaging diagnosis that is committed to improving image analysis and is capable of extracting a large number (more than 200 types) of quantitative features from medical images. Numerous studies on the application of radiomics in various systems of the body have been conducted. We reviewed current research on radiomics in spinal cord and spine system diseases and discussed the progress and challenges to provide a basis for improving the diagnosis and identification of spinal cord and spine system diseases and offer evidence-based support for precision medicine.
脊髓和脊柱系统疾病复杂多样,预后往往较差。因此,早期诊断至关重要,尤其是对于脊柱系统肿瘤,这是一种死亡率和致残率最高的恶性神经系统肿瘤。准确的诊断避免了不必要的操作。传统的医学影像学诊断仍然停留在解剖形态学的层面,有大量有用的信息可以提取和利用。放射组学是一种新的医学成像诊断方法,致力于改进图像分析,能够从医学图像中提取大量(超过200种)定量特征。已经对放射组学在身体各个系统中的应用进行了大量研究。我们回顾了目前在脊髓和脊柱系统疾病中的放射组学研究,并讨论了进展和挑战,以为改进脊髓和脊椎系统疾病的诊断和鉴定提供基础,并为精准医学提供循证支持。
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引用次数: 0
Glioblastoma multiforme of the conus medullaris with leptomeningeal dissemination that presented as intracranial hypertension: A case report and literature review 多发性髓圆锥胶质母细胞瘤伴小脑膜播散表现为颅内高压:1例报告并文献复习
Pub Date : 2021-07-01 DOI: 10.4103/glioma.glioma_15_21
Yu Hu, Wumeng Yin, Jun-peng Ma, Jia-gang Liu, Si-qing Huang, Haifeng Chen
Spinal glioblastoma multiforme (GBM) that originates from the conus medullaris is rare as only 28 cases have been reported. It is highly aggressive and usually initially presents with low back pain, sensory and motor impairment of the lower extremities, and bladder dysfunction. We herein report a unique case of GBM in the conus medullaris with leptomeningeal dissemination that initially presented with increased intracranial pressure without hydrocephalus. The patient was first diagnosed with tuberculous meningitis and received antituberculosis therapy, but the symptoms did not resolve and even worsened. Subsequent radiological imaging clearly disclosed an intramedullary lesion at the T12 level with the progression of leptomeningeal enhancement. Subtotal resection of the intramedullary lesion was performed, and pathological examination revealed the presence of GBM. To our knowledge, our case was the first with holocordal and intracranial leptomeningeal dissemination that initially presented with intracranial hypertension in the absence of hydrocephalus. Awareness of this unusually lethal condition is significant for proper diagnosis, timely treatment, and consideration of clinical prognosis.
起源于髓圆锥的多形性脊髓胶质母细胞瘤(GBM)是罕见的,仅报道了28例。它具有很强的侵袭性,通常最初表现为腰痛、下肢感觉和运动障碍以及膀胱功能障碍。我们在此报告一例独特的髓圆锥GBM伴脑膜轻散,最初表现为颅内压升高而无脑积水。患者最初被诊断为结核性脑膜炎并接受抗结核治疗,但症状没有缓解,甚至恶化。随后的x线影像清晰地显示T12水平的髓内病变,并伴有轻脑膜增强。行髓内病变次全切除,病理检查显示存在GBM。据我们所知,我们的病例是第一例在没有脑积水的情况下,最初表现为颅内高压的全方位和颅内小脑膜播散。认识到这种异常致命的疾病对正确诊断、及时治疗和考虑临床预后具有重要意义。
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引用次数: 0
Pediatric high-grade astrocytoma with piloid features of the spinal cord: A report of two cases and literature review 具有脊髓毛状特征的儿童高级别星形细胞瘤:2例报告和文献复习
Pub Date : 2021-07-01 DOI: 10.4103/glioma.glioma_10_21
Beibei Yu, Yang Lu, L. Jing, Guihuai Wang
Although the 2021 World Health Organization classification update of the central nervous system tumors redefined "pilomyxoid astrocytoma" as high-grade astrocytoma with piloid features (HGAP), the craniocerebral HGAP exhibits poorer clinical outcomes when compared to pilocytic astrocytoma. However, in the spinal cord, the paucity of information of HGAP cases inhibits the judgment of prognosis and optimal management approaches for patients with spinal HGAP. Here, we summarized the clinical characteristics, management methods, and prognosis of ten cases of spinal HGAP reported in the literature and two cases of spinal HGAP who underwent tumor surgery in our institution. Here, the detailed clinical information we provided may help clinical decision-making for such rare childhood lesions. This study was approved by the Human Research Ethics Committees in our institution on June 29, 2021.
尽管2021年世界卫生组织中枢神经系统肿瘤分类更新将“毛黏液样星形细胞瘤”重新定义为具有毛样特征的高级星形细胞瘤(HGAP),但与毛细胞性星形细胞瘤相比,颅脑HGAP表现出较差的临床结果。然而,在脊髓中,HGAP病例信息的缺乏影响了对脊髓HGAP患者预后的判断和最佳治疗方法。本文总结了文献报道的10例脊柱HGAP的临床特点、处理方法和预后,以及2例在我院行肿瘤手术的脊柱HGAP。在这里,我们提供的详细的临床信息可能有助于临床决策对这种罕见的儿童病变。本研究于2021年6月29日获得我院人类研究伦理委员会批准。
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引用次数: 0
Diagnostic challenges in epithelioid glioblastoma of the cerebellum: A case report 小脑上皮样胶质母细胞瘤的诊断挑战:一例报告
Pub Date : 2021-07-01 DOI: 10.4103/glioma.glioma_13_21
P. Aggarwal, D. Chatterjee, V. Gupta, Rekha Gupt
Epithelioid glioblastoma (eGB) is an uncommon morphological variant of isocitrate dehydrogenase wild-type GB that commonly presents as a cerebral mass in young adults and children. Here, we report the case of a 22-year-old man who presented with a cerebellar tumor. With the provisional diagnosis of pilocytic astrocytoma and adult medulloblastoma, he underwent suboccipital craniotomy with gross total excision of the tumor. On histopathological examination, he was diagnosed with eGB. Cerebellar presentation of eGB is a rare event that has not been previously described in the literature. The present case also highlights the need for differentiating eGB from its morphological mimics by carefully interpreting histopathological and immunohistochemical examination findings.
上皮样胶质母细胞瘤(eGB)是异柠檬酸脱氢酶野生型GB的一种不常见的形态变体,通常在年轻成人和儿童中表现为脑肿块。在这里,我们报告了一个22岁的男子,他表现为小脑肿瘤。根据毛细胞星形细胞瘤和成人髓母细胞瘤的临时诊断,他接受了枕下开颅手术,并对肿瘤进行了全面切除。在组织病理学检查中,他被诊断为eGB。eGB的小脑表现是一种罕见的事件,以前在文献中没有描述过。本病例还强调了通过仔细解释组织病理学和免疫组织化学检查结果来区分eGB与其形态学模拟物的必要性。
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引用次数: 0
Establishment and evaluation of a Sprague-Dawley rat model of intramedullary spinal cord glioma Sprague-Dawley大鼠脊髓髓内神经胶质瘤模型的建立及评价
Pub Date : 2021-07-01 DOI: 10.4103/glioma.glioma_16_21
Dong-kang Liu, Guo-qing Yi, J. Wang, Guihuai Wang
Background and Aim: Intramedullary spinal cord glioma has no evident boundary with normal spinal cord tissue. The rate of successful surgical resection of intramedullary spinal cord glioma is low. Well-established animal models for intramedullary spinal cord glioma can help promote translation from related basic therapy research to clinical applications. In this study, we established a rat model of intramedullary spinal cord glioma. Materials and Methods: A total of 23 male Sprague-Dawley (SD) rats were randomized into blank control (n = 3) and experimental (n = 20) groups. The blank control group received intramedullary injection of Dulbecco's modified Eagle medium (DMEM) and the experimental group was injected with DMEM containing C6 glioma cells. The neurological states of these rats were evaluated using the Basso, Beattie, and Bresnahan scale (BBB). Tumor sizes were measured by magnetic resonance imaging. The histopathological analysis was performed to observe the growth of infiltrating tumors. All procedures involving animals were approved by the Ethics Committee of the Laboratory Animal Facility Biomedical Analysis Center, Tsinghua University (Beijing, China; approval No. 17-WGH1). Results: On postoperative 7 days, the experimental group presented with a significant progressive decrease in motor function (mean BBB score 15.00 ± 1.20) compared with the blank control group (20.67 ± 0.47, P < 0.01). All rats in the experimental group showed exponential tumor growth and had an average survival of up to 5 weeks after tumor cell implantation. The tumor sizes were 3.18 ± 0.21 mm3, 68.55 ± 3.38 mm3, and 345.28 ± 22.57 mm3 on postoperative 7, 14, and 28 days. The histopathological analysis illustrated that the growth of infiltrating tumors followed the longitudinal axis of the spinal cord. Conclusions: Thus, we have established a SD rat model of intramedullary spinal cord glioma, and we found that our findings are reproducible and homogeneous. These positive results provide solid bases for further studies of intramedullary spinal cord glioma.
背景与目的:髓内脊髓胶质瘤与正常脊髓组织无明显分界。髓内神经胶质瘤手术切除成功率低。已建立的髓内神经胶质瘤动物模型有助于促进相关基础治疗研究向临床应用的转化。本研究建立了大鼠脊髓髓内胶质瘤模型。材料和方法:将23只雄性Sprague-Dawley(SD)大鼠随机分为空白对照组(n=3)和实验组(n=20)。空白对照组接受Dulbecco改良Eagle培养基(DMEM)的髓内注射,实验组注射含有C6神经胶质瘤细胞的DMEM。使用Basso、Beattie和Bresnahan量表(BBB)评估这些大鼠的神经状态。肿瘤大小通过磁共振成像测量。进行组织病理学分析以观察浸润性肿瘤的生长。所有涉及动物的程序均由清华大学实验动物设施生物医学分析中心伦理委员会批准(中国北京;批准号:17-WGH1)。结果:与空白对照组(20.67±0.47,P<0.01)相比,实验组大鼠术后7天运动功能显著下降(平均血脑屏障评分15.00±1.20),实验组所有大鼠肿瘤均呈指数级生长,肿瘤细胞植入后平均存活5周。术后7、14和28天,肿瘤大小分别为3.18±0.21 mm3、68.55±3.38 mm3和345.28±22.57 mm3。组织病理学分析表明,浸润性肿瘤的生长遵循脊髓纵轴。结论:因此,我们建立了脊髓髓内胶质瘤的SD大鼠模型,我们发现我们的发现是可重复和均匀的。这些阳性结果为进一步研究髓内神经胶质瘤提供了坚实的基础。
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引用次数: 0
Unexpected upper limb compartment syndrome due to venous thrombosis in frontal glioma surgery: A case report 额神经胶质瘤手术中静脉血栓形成引起的意外上肢隔室综合征1例
Pub Date : 2021-04-01 DOI: 10.4103/glioma.glioma_4_20
A. Dalvi, A. Shetty, G. Gangakhedkar, Pallavi V. Waghalkar
Although it is well known that 49% cases of upper limb deep-vein thrombosis are due to malignancies and the likelihood of venous thromboembolism is increased in patients with high grade gliomas due to the heightened prothrombotic milieu, requisite preoperative laboratory coagulation studies are not performed routinely in these patients to decide whether appropriate antithrombotic medications are required preoperatively. In addition, it is controversial whether antithrombotic therapy should be initiated before neurosurgery in view of the risk of intraoperative bleeding. Here, we have described the case of a 29-year-old female with high grade frontal malignant astrocytoma who developed the extremely rare complication of upper limb compartment syndrome postoperatively. The patient had no history of thrombotic events, and her basic laboratory parameters were not deranged in the pre-operative period. This rare case, supported with a literature review, suggested that the risk of thrombosis is increased in high grade and large gliomas, making us rethink the overall battery of investigations and perioperative medical management of such cases. We strongly recommend peri-operative coagulation studies and appropriate antithrombotic measures along with vigilant perioperative monitoring to avoid thrombotic complication in this subset of patients.
尽管众所周知,49%的上肢深静脉血栓形成病例是由恶性肿瘤引起的,并且在高级别胶质瘤患者中,这些患者没有常规进行必要的术前实验室凝血研究,以决定术前是否需要适当的抗血栓药物。此外,鉴于术中出血的风险,是否应在神经外科手术前开始抗血栓治疗也存在争议。在这里,我们描述了一例29岁的女性,患有高级额恶性星形细胞瘤,术后出现了极为罕见的上肢间隔综合征并发症。患者没有血栓性事件史,术前基本实验室参数没有紊乱。这一罕见病例得到了文献综述的支持,表明高级别和大型胶质瘤中血栓形成的风险增加,这让我们重新思考这类病例的整体调查和围手术期医疗管理。我们强烈建议进行围手术期凝血研究,采取适当的抗血栓措施,同时进行警惕的围手术期监测,以避免这类患者出现血栓并发症。
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引用次数: 0
CpG2 hypermethylation in the CD95L promoter is associated with survival in patients with glioblastoma: An observational study CD95L启动子CpG2高甲基化与胶质母细胞瘤患者的生存相关:一项观察性研究
Pub Date : 2021-04-01 DOI: 10.4103/glioma.glioma_8_21
N. F. Farrukh Hameed, Yuyao Zhou, Lei Jin, Ying Xu, J Zhang, Hong Chen, James R. Xue, Jinsong Wu
Background and Aim: Blockade of CD95/CD95 ligand (CD95 L) signaling is a promising therapeutic approach for the treatment of glioblastoma (GBM), while methylation of a single cytosine-phosphate-guanine site (CpG2) upstream of the CD95 L promoter has been identified as a prognostic biomarker for GBM. Here, we conducted the first investigation of CD95 L expression and CpG2 methylation levels in the CD95 L promoter in GBM patients. Materials and Methods: In this observational study, tissue samples were collected from 69 patients with a primary diagnosis of World Health Organization Grade IV GBM treated at the Department of Glioma Surgery, Huashan Hospital, Shanghai Medical College, Fudan University and tested for CD95 L expression using immunohistochemistry (IHC). The CpG2 methylation status of the samples was also evaluated, and its impact on overall survival (OS) was assessed by univariate analysis. The study was approved by the Hospital Institutional Review Board (approval No. 220) on July 7, 2015. Results: The IHC results showed a CD95 L detection rate of at least 43.5% for tissue samples with IHC scores of 2+ or 3+ and 78.3% for those with IHC scores of 1+, 2+, or 3+. Patients with high CpG2 methylation levels (≥52% higher than the median value; n = 32) had significantly longer median survival compared with those with low CpG2 methylation levels (n = 29) (22.95 vs. 14.5 months; P = 0.0084). GBM patients who underwent gross total tumor resection (n = 57) showed similar results. Those in the high CpG2 methylation group had longer median OS compared with that of patients in the low CpG2 methylation group (23.5 vs. 18.0 months; P = 0.0141). Conclusions: Our results showed a significant prevalence of CD95 L expression in GBM patients, whereas CpG2 hypermethylation within the CD95 L promoter was positively associated with survival. These findings support that CD95/CD95 L signaling blockade has potential as a therapeutic strategy targeting treatment-resistant GBM.
背景与目的:阻断CD95/CD95配体(CD95 L)信号是治疗胶质母细胞瘤(GBM)的一种很有前景的治疗方法,而CD95 L启动子上游单个胞嘧啶-磷酸-鸟嘌呤位点(CpG2)的甲基化已被确定为GBM的预后生物标志物。在这里,我们首次研究了GBM患者CD95 L启动子中CD95 L的表达和CpG2甲基化水平。材料与方法:本观察性研究收集了在复旦大学华山医院胶质瘤外科治疗的69例初诊为世界卫生组织IV级GBM患者的组织样本,采用免疫组织化学(IHC)检测CD95 L的表达。还评估了样品的CpG2甲基化状态,并通过单变量分析评估其对总生存期(OS)的影响。该研究于2015年7月7日获得医院机构审查委员会批准(批准号220)。结果:免疫组化结果显示,免疫组化评分为2+、3+的组织标本CD95 L检出率至少为43.5%,免疫组化评分为1+、2+、3+的组织标本CD95 L检出率至少为78.3%。CpG2甲基化水平高的患者(高于中位数≥52%;与CpG2甲基化水平较低的患者(n = 29)相比,n = 32)的中位生存期明显更长(22.95 vs 14.5个月;P = 0.0084)。接受肿瘤全切除术的GBM患者(n = 57)显示了类似的结果。与低CpG2甲基化组相比,高CpG2甲基化组患者的中位生存期更长(23.5个月vs 18.0个月;P = 0.0141)。结论:我们的研究结果显示,CD95 L在GBM患者中有显著的普遍表达,而CD95 L启动子内的CpG2超甲基化与生存率呈正相关。这些发现支持CD95/CD95 L信号阻断有潜力作为治疗耐药GBM的治疗策略。
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引用次数: 1
Inhibition of histone deacetylase 6 by tubastatin A as an experimental therapeutic strategy against glioblastoma tubastatin A抑制组蛋白去乙酰化酶6对胶质母细胞瘤的实验性治疗策略
Pub Date : 2021-04-01 DOI: 10.4103/glioma.glioma_5_21
Alejandro Urdiciain, P. Bermudez-Lekerika, B. Meléndez, Juan Rey, M. Idoate, Natalia A. Riobo-Del Galdo, J. Castresana
{"title":"Inhibition of histone deacetylase 6 by tubastatin A as an experimental therapeutic strategy against glioblastoma","authors":"Alejandro Urdiciain, P. Bermudez-Lekerika, B. Meléndez, Juan Rey, M. Idoate, Natalia A. Riobo-Del Galdo, J. Castresana","doi":"10.4103/glioma.glioma_5_21","DOIUrl":"https://doi.org/10.4103/glioma.glioma_5_21","url":null,"abstract":"","PeriodicalId":12731,"journal":{"name":"Glioma","volume":"4 1","pages":"27 - 33"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49263896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Progress on glioma surgery and multimodal treatments 神经胶质瘤手术及多模式治疗进展
Pub Date : 2021-04-01 DOI: 10.4103/glioma.glioma_9_21
M. Berger
{"title":"Progress on glioma surgery and multimodal treatments","authors":"M. Berger","doi":"10.4103/glioma.glioma_9_21","DOIUrl":"https://doi.org/10.4103/glioma.glioma_9_21","url":null,"abstract":"","PeriodicalId":12731,"journal":{"name":"Glioma","volume":"4 1","pages":"19 - 21"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48099461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Glioma
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